INTER-OFFICE MEMORANDUM County Manager Action Form TO: FROM: SUBJECT: Thomas C. Andrews, County Manager Doug Carl, Interim Director Human Services Department Jefferson Place Emergency Shelter - Grant Application Emergency Food and Shelter Program Federal Emergency Management Agency DATE: October 9, 2006 REQUESTED ACTION BY MANAGER: Request approval to submit and accept a one year grant from the Federal Emergency Management Agency for participation in the Emergency Food and Shelter Program to support the operation associated with the Jefferson Place Emergency Shelter in the amount of $30,000. CRITICAL DATE FOR ACTION: October 18, 2006 PURPOSE: This grant supplements the operational cost associated with operating Jefferson Place Emergency Shelter. DISCUSSION: Funds from this grant are used to subsidize the operational services cost associated with the Jefferson Place Emergency Shelter. There is no cash match requirement for this grant. IMPACT: This grant will assist Fulton County in continuing to provide Emergency Shelter to homeless individuals in Fulton County. AVAILABILITY OF FUNDING: There is no cash match requirement for this grant. COORDINATION: The Finance Department will coordinate this grant with the Federal Emergency Management Agency CONTACT PERSONS: Doug Carl, Interim Director, Human Services Department. RECOMMENDATION: Approval to submit and accept this grant from the Federal Emergency Management Agency ATTACHMENTS: Jefferson Place Emergency Shelter's grant application. WORDING: Request approval to apply and accept a one year grant in the amount of $30,000. from the Federal Emergency Management Agency for the Jefferson Place Emergency Shelter. There is no cash match requirement for this grant.
WORDING: Request approval to apply and accept a one year grant in the amount of $30,000. from the Federal Emergency Management Agency for the Jefferson Place Emergency Shelter. There is no cash match requirement for this grant.
SECTION 1: AGENCY INFORMATION Application Prepared, Date: October 5, 2006 Legal Name of Agency:* Program Name: Board of Commissioners of Fulton County Georgia Jefferson Place Emergency Shelter Mailing Address, Street: 115 MLK Jr. Drive, Suite 400 City: Atlanta State: GA Zip: 30303 Program Site Address, Street: 1135 Jefferson Street City: Atlanta State: GA Zip: 30318 County: Fulton Primary Contact Person: Contact Person Title: Leonard R. Westmoreland Division Manager-Office of Emergency & Transitional Housing Telephone: 404-730-6779 FAX: 404-224-2099 Alternative Phone: 404-730-7944 Email: leonard.westmoreland@co.fulton.ga.us Alternate Contact Person: Alternate Contact Title: Telephone: Alternative Phone: FAX: Email: Include Alternate Contact in all communications? dyes NO Executive Director/CEO: Doug Carl Executive Director/CEO Telephone: 404-730-7187 Alternative Phone: 404-730-5518 FAX: 404-730-6889 Email: doug.carl@co.fulton.ga. us Include Executive Director in all communications? CE3YES D NO What year did agency begin delivering services? 1991 What year was agency incorporated? 1991 What year did program begin delivering services? 1991 Agency website (if applicable): www.fultonhumanservices.org *lf an agency is serving as a fiscal agent for another agency, the name of the agency should read "Agency X fiscal agent for Agency Y" and the mailing address should be the fiscal agent's address Page 1 of 18
PhaM28 Application for Program Fund* & Certification of Eligibility SECTION 2: FUNDING REQUEST Please indicate below the categories for which the applicant program is applying for funding and the amounts requested by category. The maximum request per program is $30,000. Organizations submitting multiple program applications may request up to a total of $45,000. Then complete pages 8-18 as appropriate. Do NOT submit blank or unused pages in your final application. Please be aware that once funds are awarded to a category, Board approval is required to change the use of funds. CATEGORY 1. MASS SHELTER (complete Category 1 on pages 9-10) 2. MASS FEEDING (complete Category 2 on pages 11-12) 3. OTHER FOOD (complete Category 3 on pages 13-14) 4. TEMPORARY LODGING (complete Category 4 on pages 15-16) 5. RENT/MORTGAGE ASSISTANCE (complete Category 5 on pages 17) 6. UTILITY ASSISTANCE (complete Category 6 on page 18) TOTAL FUNDS REQUESTED FOR THIS PROGRAM (Do not exceed $30,000) FUNDING REQUEST 30,000.00 30,000.00 Executive Director Signature: Agency: Futon cpi man Services Department - Federal Employer ID#: Board Chair, Signature: Typed Name: 58-6001729 Karen C. Handel Page 2 of 18
PntMO 29 Application for Program Funda & Certification of Eligibility due by November 1, 2006, by 12:00 p.m. SECTION 3: CERTIFICATION FORM Please review the following Local Recipient Organization (LRO) Certification Form carefully. Check each item and fill in the blanks as indicated. Note that if any agency meets all of the criteria except the annual audit and/or accounting system, another agency that meets these requirements may be approved to serve as the fiscal agent. Signing this form does not guarantee funding. The form is used only to certify to the Local Board and National Board that your agency is eligible to receive EFSP funds. Incompletely filling out this section will cause your application to be denied. As a recipient of Emergency Food and Shelter National Board Program (EFSP) funds made available for and as the duly authorized representative of the below-named agency, I certify that my public or private organization: V (Check boxes below) El 1 Has the capability to provide emergency food, aid, and/or shelter services rg 2. Will use funds to supplement and extend existing resources and not to substitute or reimburse ongoing programs and services El 3. Is non-profit or an agency of the government D Copy of 501 (c )(3) ruling attached SI 4. Has an accounting system or fiscal agent approved by the Local Board El 5. Conducts an annual audit or can provide audited financial statements with management letters if relevant El 6. Understands that cash payments are not eligible under EFSP El 7. Understands that EFSP funds cannot be used for staff salaries ni 8. Understands that interest income must be reported on final report and used on allowable program *** expenditures El 9. Has or will secure a Federal Employee Identification Number n 10. Practices non-discrimination (if an agency with a religious affiliation, will not refuse service to an applicant " Bl based on religion, nor engage in religious proselytizing or religious counseling with federal funds) D 11 If private, not for profit, has a voluntary board ra 12. Will comply with the Responsibilities and Requirements Manual, particularly the Eligible and 121 Ineligible Costs section El 13. Will provide required reports to the Local Board El Interim Report and 2 nd Payment Request no later than July 15, 2007 El Final Report and documentation as required by the National Board, no later than February 15,2008 D At any time during the phase, may be asked to submit selected rent, mortgage, or utilities assistance files at the discretion of the Local Board and EFSP coordinator. «14. Will expend monies only on eligible costs and keep complete documentation (copies of canceled checks - ^ front and back, invoices, receipts, etc.) on all expenditures for a minimum of three years ni 15. Will spend all funds and close out the program by December 31, 2007 and return any unused funds to the ^ National Board ($5 or more) 16. Will close all separate bank accounts (or bring to zero balance) and provide complete documentation of El expenses to the Local Board, if requested, no later than one month following my jurisdiction's selected end-of -program El 17. Will comply with OMB Circular A-133 if receiving over $300,000 in Federal funds r, 18. WIN comply with lobbying prohibition certification and disclosure of lobbying activities (if applicable if KSI receiving more than $100,000 in Emergency Food and Shelter Program funds El 19. Has no known EFSP compliance exceptions in this, or any other jurisdiction El 20. If funded, will send representation to the required LRO training on February 15", 2007 Executive Director Signature: Typed Name: Organization: Program Staff Signature: Program staff typed name & title: Staff responsible for reporting, if other than ED or Program Staff Signature: Report Staff Typed Name and Title Doug Carl Fulton County Human Services Nicola Hosier, HSD Fii Page 3 of 18
SERVICE ELIGIBILITY SECTION 4: Please give a brief description of your overall program. Use only the space provided here. The supervised Emergency Shelter provides 150 beds, 365 days per year for unaccompanied males, 18 years of age and older. Intake hours are daily 3:00 p.m. - til capacity. Customers are required to present picture ID as verfication of their identity. Each customer is presented with a copy of the rules at Intake. Compliance is mandatory. Customers are allowed to stay for a maximum of 120 days within a calendar year. Guest are required to shower upon check-in and attend one 45 minute program orientation facilitated by supportive services case management staff. The supportive service requirements are that the customer express a desire to receive these services. There is no charge for services. Please check if your agency targets specific client populations by choosing up to the top three (3) from the list below: Chemically addicted _ a Single women People with AIDS/HIV _ Families with children Domestic violence victims _ I _ Sin e men 9 Mentally disabled _ _ Unaccompanied minors Elderly _ _ Native American Veterans Q Other minorities Other targeted populations: NO special populations targeted / serve general population Please give a brief description of specific services provided that target the needs of the population(s) checked above. Use only the space provided here: The Jefferson Place Emergency Shelter provides case management services, health care, substance abuse and mental health counseling and referral, educational upgrades, workforce preparation and employment services consumer credit and finanical counseling, transportation assistance, resettlement assistance and aftercare services. Please give a brief description of other services provided by your organization. Use only the space provided here. The Fulton County Human Services Department provides a continuum of homeless services through its Jefferson Place Emergency and Transitional Housing complex. Additionally, services targeting seniors, youth, the under and unemployed, disabled, homeless and those at risk of becoming homeless are provided through the Human Services Department's community based service delivery network. Page 4 of 18
due by November 1, 2006, by 12:00 p.m. Does this program utilize the services of and/or involve homeless or formerly homeless persons in the organization's daily operation (I.E. strategic planning, governance). El 1 YES D 1 NO If yes, describe how they are involved. Use only the space provided here. The homeless and formerly homeless are throughly involved in the daily operation of Jefferson Place. The formerly homeless are employed as staff and homeless customers are involved in the governance of Jefferson Place through their participation on programs and services committees. In the space below, please summarize how EFSP funds will supplement your current services. The requested EFSP funds will be used to supplement the operational cost associated with the provision of 150 emergency shelter beds per night, 365 nights per year for homeless adult males. These funds will allow for the increase in quanity and expansion in composition of customer consumable personal hyigene supplies. Page 5 of 18
What number of your following zip codes: # ZIP CODE 30002 30004 30005 30009 30021 30022 30023 30030 fs m 30031 tm 30032 30033 30034 30035 30036 30037 30038 30058 30072 30074 30075 30076 30077 H i EMERGENCY FOOD AND SHELTER PROGRAM due by November 1, 2006, by 12:00 p.m. clients to be served with funds from this EFSP jurisdiction live in the W m 20 15 15 30083 30084 30085 30086 30087 30088 30097 30213 30268 30272 30291 30294 30302 30303 30305 30306 30307 30308 30309 30310 10 15 ZIP CODE 30312 30313 30314 30315 mi 30316 30317 30318 30319 30320 30321 30322 30324 30325 30327 30328 30329 30330 30331 30333 30334 30336 30338 M I 1n 2 m 1 4 ZIP CODE 30339 30340 30341 30354 30356 30357 30358 30359 30360 30362 30366 30368 30370 30371 m * ZIP CODE 30375 30377 30378 30342 30379 i 30344 30384 30345 30385 30346 ft 30394 30347 30396 30348 31106 30349 H 31107 30350 31119 w 31131 31132 31139 31141 31145 31146 31150 31195 31196 31197 39901 Clients to be served with funds from this jurisdiction are residents of (check all that are appropriate): 'W City of Atlanta City of College Park (Fulton County) DeKalb County Fulton County If agency serves clients from a defined geographic area smaller than those listed above, please specify the area(s) (for example: Mid town, Sandy Springs): ' This frame provides limited space, and will lock after 750 characters. Please format your narrative accordingly Page 6 of 18
What percentage of your clients, to a total of 100%, fall within the following annual inconne ranges: 100% $0 - $10,000 (50% or less of 2006 Federal Poverty Guideline for family of 4) $10,001 -$20,000 (51 %-100% of 2006 FPG for family of 4) $20,001-$30,000 (101%-150% of 2006 FPG for family of 4) $30,001 -$40,000 (151 %-200% of 2006 FPG for family of 4) More than $40,001 Did this agency receive EFSP funds from this jurisdiction during Phase 24? If yes, what is your LRO Number? rm YES nsn NO Did this agency receive funds from other jurisdictions during Phase 24? YES ElNO If yes, which jurisdictions awarded funds? If yes, does agency have any outstanding compliance exceptions in other jurisdictions? Does this agency anticipate receiving funds from other jurisdictions during? YES G3 Is your agency physically located within the geographical area that you serve with EFSP funds for the Atlanta/College Park/DeKalb/Fulton jurisdiction? YES rm NO What other agencies, if any, provide similar assistance to residents in your service area? The other shelters that are in close proximity to Jefferson Place are the Altanta Union Mission, Salvation Army, Peachtree/Pine and Gateway. Note below any other service-providing agencies with which this program collaborates, and describe in a few words or short phrase what the collaboration covers. Jefferson Place collaborates with the Achor Center, Partnership Against Domestic Violence, St Jude's Recovery Center, Atlanta Children's Shelter, Buckhead Christian Ministry, Traveler's Aid, Community Concerns, Carpenter's House, The Drake House, St. Joseph Mercy Care, Hosea Feed the Hungry, Our Common Welfare, Making A Wish, YMCA of Greater Atlanta, Genesis Center, Nicholas/Boulevard House, Decatur Cooperative Ministry and a host of other providers in the provision of resettlement assistance. Will this EFSP award assist you in securing or leveraging funds from other sources? ran YES NO Page 7 of 18
What is the total operating budget for this agency (include all costs)? 3,500,000 What is the total operating budget for this program (include all costs)? 1,500,000 Page 8 of 18
SECTION 5: SERVICE CATEGORY REQUEST DETAIL Category 1: MASS SHELTER Mass Shelter (5 or more beds) Over 50% of funding should come from sources other than EFSP. EFSP dollar amount requested for Mass Shelter funds: What is the anticipated operating budget for the Mass Shelter program, excluding the requested EFSP funds? $30,000 $1,500.000 List other anticipated sources of funding during this Phase (do not include EFSP funds): Type of funding Federal Funds State Funds Local Gov't Other, specify: Other, specify: Pending $s Committed $s 1,500.000 Specific Source(s): grant program, department, etc. Fulton County Board of Commissioners Totals What is this facility's legal occupancy limit? Which months of the year is the shelter open? What are the daily hours of operation? 1,500.000 150 Beds 12 months per year 24 hours per day NA What is the maximum length of stay permitted? 120 days per calendar year What year did the shelter originally open? 1991 Is a nightly fee required for service? YES NO If Yes: 1. What is the nightly rate? 2. How many clients do you anticipate serving with EFSP funds who do not have the ability to pay? SNA NA 3. What method does your agency use to allocate EFSP funds to support clients who cannot pay? NA Page 9 of 18
If participation in any class or religious service is required of clients, explain. Emergency Shelter guest are required to attend a 45 minute program orienation during their first night in the shelter. This is an attempt to familiarize the customer with the services available to them beginning with their first night. Page 10 of 18